CALEXICO, Calif. — José Alfredo Reyes’ wife and son pulled on personal protective gear and entered his San Diego hospital room.
“Can you hear us?” Margarita Reyes said. Her husband’s eyes remained shut, but his body twitched.
She leaned in low to his ear and told him that his elderly mother, his children and his grandchildren would all be OK. She told him she loved him.
Ten minutes later, José Alfredo Reyes, 59, was dead.
José Alfredo Reyes, a longtime farmworker in this agricultural county of 181,000, is one of thousands in Imperial County to be sickened or killed by COVID-19, the disease spawned by the coronavirus. Imperial County, which is 85% Hispanic, has consistently had one of the highest death rates in the United States, at a time when Latinos are one of the hardest-hit ethnic groups in the pandemic, according to data compiled by USA TODAY.
Farmworkers here pull from the ground the lettuce and broccoli that end up on dinner plates across America. This work often means low wages, poor nutrition and scant access to health care – factors that put them in the crosshairs of the coronavirus.
Many of Imperial County’s residents are U.S. citizens yet are often treated in the fields like foreign visitors without basic workers’ rights. They live among industrialized farms surrounded by desert. The opulent mansions of San Diego are a two-hour drive west.
It is one of the poorest and unhealthiest places in California, with high rates of unemployment and child poverty. Nearly a quarter of families depend on federal assistance for food.
Imperial County’s suffering mirrors the struggles of many Latinos across the nation, who are more likely than non-Hispanic white Americans to face poverty and poor nutrition after centuries of being pushed into low-paying jobs and segregated communities. Now, they are also more likely to die from COVID-19. As of Oct. 15, Imperial County had counted 335 COVID-related deaths. That’s 185 deaths per 100,000 residents – nearly triple the national rate of 66 per 100,000. Neighboring San Diego County, which has half the percentage of Hispanic residents, has a drastically lower death rate (26 per 100,000).
“I thought it was going to be as bad as it got in San Diego,” said Dr. Christian Tomaszewski, chief medical officer at El Centro Regional Medical Center, one of Imperial County’s two hospitals. “It was a ton worse.”
Farmworkers in California’s Imperial Valley risk their health in order to pay the bills
California’s farmworkers are left with a difficult decision during the pandemic – risk their health and life at work or go without food and rent money?
Omar Ornelas and Sandy Hooper, USA TODAY
Maria Guadalupe Ortega Valladarez was in her Calexico apartment in May when she felt the first pangs of a headache.
She thought it was yet another flare-up from her failing kidneys, an ailment derived from decades of farm work. Life in Imperial Valley had led to a host of health problems, including diabetes, high blood pressure and high cholesterol.
Then, the nagging headache morphed into body aches, fever and loss of appetite. This was something different. Her son-in-law drove Ortega Valladarez, 60, to the hospital, where she tested positive for COVID-19.
“I was surprised,” she said. “I have tried to protect myself, because I know that I’m sick.”
She spent two nights alone in the hospital. The only people who saw her were the doctors and nurses dressed in gowns and masks.
Originally from Mexicali, Mexico, Ortega Valladarez, one of 14 siblings, migrated to the United States with her family when she was 18 and immediately started laboring in the fields with her father and four siblings.
Back then, growers weren’t required to provide shade for farmworkers. She and her family broiled under the sun during eight-hour shifts, earning less than $5 an hour.
“It felt like death,” she remembered.
During her best years, she earned $19,000 annually. As she had kids, earning enough to cover rent, food and school supplies became a constant challenge. In the fields, there was no time for healthy meals. Her diet turned to sandwiches or tacos with meat and beans.
When she was around 50, Ortega Valladarez developed symptoms of diabetes. She felt tired, lethargic and thirsty. It was no surprise: Her whole family had the disease and three siblings had died of it.
“I didn’t deal with it because I was working,” she recalled. “They didn’t give me time to go to the doctor.”
At around the same time, her kidneys began to fail, and she was diagnosed with cataracts, high cholesterol and high blood pressure. She started going blind in her left eye, which forced her to stop working the fields two years ago.
Today, Ortega Valladarez shares a three-bedroom apartment with her daughter, son-in-law and their two kids. She scrapes by on $900 monthly Social Security checks.
“I have the desire to work, but I can’t,” she said.
After her two-day hospital stay in May, Ortega Valladarez returned home to find her daughter, Alejandra Rodríguez, 25, sick in bed, awaiting her own COVID-19 test results. She tested positive and spent four nights in the hospital, receiving oxygen.
Ortega Valladarez cried, fearing her daughter would die.
“She can’t die, because I can’t take care of two babies now,” Ortega Valladarez recalled thinking. “I preferred to die, instead of her.”
Rodríguez improved and returned home, and mother and daughter convalesced together in the apartment: Ortega Valladarez in the bedroom, her daughter on the couch. They passed the time phoning friends or scrolling Facebook. They watched telenovelas, movies and the news, which offered endless updates on the pandemic and virus-related deaths. Ortega Valladarez’s hair began falling out from the stress.
After three weeks, they felt better and were clear to leave the apartment.
Ortega Valladarez counts herself as one of the lucky ones. She beat the virus with no noticeable side effects.
“Dios fue muy grande,” she said. God was great.
How do you compare?
Featured County, State
Deaths per 10,000:
National deaths per 10,000: 5.6
Population breakdown by race:
Entered , State
Deaths per 10,000:
National deaths per 10,000: 5.6
Population breakdown by race:
Select your location to compare with Featured County, State
Note: some areas of the United States are unincorporated or independent from a county or parish. In a few select cases, such as New York City and Denali Borough, Alaska, these areas may not be available for comparison in this interactive graphic because the scope of the data is not universally available.
Cases and deaths
Imperial County, California, has a COVID-19 death rate of compared to in . Imperial County is also home to a large population of Hispanic residents, with compared to in .
One key comorbidity of COVID-19 is adult obesity, and it’s likely that your location has fewer residents with obesity compared to Imperial County, California. The adult obesity rate in Imperial County is whereas in it is .
Food insecurity is also a common problem in Imperial County, where of children are eligible for free or reduced price lunch compared to in .
Are you experiencing unemployment? In Imperial County, of the population is unemployed compared to in .
Consider your health insurance status. In Imperial County, of the population is uninsured whereas in that rate is .
Are you living below the poverty line? In Imperial County, of the population is under the poverty line compared to with .
Sources: Milken Institute Research Department COVID-19 Community Explorer, COVID-19 Data Repository by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University and the U.S. Census Bureau’s 2018 U.S. American Community Survey. Data last updated: Sept. 1, 2020.
Imperial County is a vast but improbable agricultural area. The arid, desert climate made it unsuitable for crops, but a series of canals built in the early 1900s to divert the Colorado River allowed farmers to plant lettuce, alfalfa and more — thirsty plants that could never grow there naturally. In the 1930s, at the behest of the increasingly powerful farming community, federal engineers created the 82-mile All-American Canal, an aqueduct to irrigate farms across 500,000 acres and to power hydroelectric plants.
The canal network funneled water into the hands of a few farmers on the American side of the border and laid the groundwork for large-scale industrial farms, consolidating power in the region for decades to come, said Paul Kibel, an environmental law professor at the Golden Gate University School of Law in San Francisco. But as laborers across the country were unionizing to collectively bargain for better wages and working conditions, farmworkers were blocked from collective bargaining by the 1935 National Labor Relations Act, credited with lifting tens of millions of mostly white and Black workers into the middle class.
Frustrated by poor pay and working conditions, Imperial Valley’s farmworkers, who were mostly Mexican or Chicano, launched repeated strikes in the 1930s. They were bitterly and violently opposed by local government, farmers and the producers who bought the vegetables. In early 1934, police and vigilantes surrounded a hall where hundreds of strikers had gathered with their families, blasting the building with tear gas and fire hoses as frightened women and children scrambled out through the windows. Local newspapers whipped up anti-worker sentiment, and police burned down strike encampments after declaring that picketing was illegal, in part due to fears that communists were helping organize.
Labor organizers – some of whom were communists – eventually gave up trying to unionize the workers. Farmers and producers retained the upper hand.
In the 1940s, another federal initiative would leave a lasting impact on Imperial County. The Mexican Agricultural Labor Program, also know as the “Bracero Program,” drew 5 million Mexican workers to the United States over its 22-year history – many of them to the Imperial Valley. Named for the Spanish word for arms — brazos — braceros were Mexican citizens permitted to work as seasonal agricultural workers in the U.S.
Started in 1942, the program ostensibly provided better working conditions in the American fields, including shelter and sanitation. But it was entirely controlled by the growers and enforced with armed guards, said Kate Bronfenbrenner, a labor-union professor at Cornell University in New York. Workers couldn’t leave for other jobs and anyone deemed a troublemaker could be “sent home” to Mexico, she said. Growers and producers supported the program, she said, because it gave them more control over the workforce and reduced the threat of strikes.
As a result, the labor force was constantly turning over, making it hard for workers to settle down and buy homes – a system that cemented a legacy of poverty and low wages in Imperial County, Bronfenbrenner said.
“It was a servant-plantation structure,” she said of the bracero program. “It’s the same thing as any colonial structure anywhere: The business of making money depends on having a peon culture.”
Experts said the ongoing labor inequities have made it hard for the descendants of those braceros to join the middle class.
According to the U.S. Census Bureau, California’s farmworkers, who are mostly Latino, earn about $30,000 annually, although labor experts say they usually earn less than that because farm work is so seasonal. About 20% of California’s estimated 1 million farmworkers receive unemployment in a given year, according to state labor officials.
Across the country, farmworkers are rarely represented by unions the way autoworkers, teachers and bus drivers are. That lack of representation often shuts them out of access to unemployment pay, worker’s compensation and health insurance. The United Farm Workers, the well-known labor union once led by César Chávez and Dolores Huerta in Central California, represents only a small portion of the nation’s roughly 3 million farmworkers.
“We are this winter salad bowl for the country, and we grow so much food for the country,” said Sara Griffen, executive director of the Imperial Valley Food Bank. “Yet, we have one of the highest food insecurity rates in the country.”
As the pandemic surfaced in Imperial County, nurses and doctors at El Centro Regional Medical Center, about 20 miles from the U.S.-Mexico border, raced from patient to patient. “Code Blue” sirens echoed relentlessly through the halls. Another COVID-19 patient was slipping into cardiac arrest. An outdoor, air-conditioned tent was erected to screen patients. Another tent on the other side of the hospital doubled as a medical-surgical unit.
From April through August, the 161-bed facility burst with more than 1,400 COVID-19 patients, Tomaszewski said. Staffers worked 10- to 13-hour shifts as COVID-19 patients struggled on ventilators in the hospital’s small emergency room, waiting for a more permanent bed to open up. At the height of the surge, doctors were intubating two to three people a day – far more than it ever had.
Patients often looked scared and suffered from dyspnea, or “air hunger,” gasping “like when you take a fish out of water,” Tomaszewski said.
Nurses were devastated by the deluge of patients.
“The nurses really got attached to these patients, and they thought they were making progress,” he said, “and suddenly somebody who was 40, 50 would crash, burn and die.”
After consulting with state leaders, officials at El Centro transferred more than 250 intubated patients to hospitals more than 600 miles away in San Francisco and Sacramento. Soon after, the California National Guard helped open an 80-bed field hospital in the nearby Imperial Valley College gymnasium.
Even as the crush of patients began to ebb around late summer, questions nagged at Tomaszewski: How did his hospital end up with so many COVID-19 patients and, more importantly, why were so many critically ill?
One reason, he learned as he reviewed the data, was the area’s high rate of obesity, diabetes and hypertension, which make people more vulnerable to the virus and make them sicker once they get it.
Hispanics are one of the most likely groups to be obese (44.8%), second only to non-Hispanic Black Americans (49.6%), according to the Centers for Disease Control and Prevention.
There’s also a high rate of lung disease in the region, due to poor air quality, Tomaszewski said. The Environmental Protection Agency in 1987 formally recognized that blowing dust in Imperial Valley, from vehicles on dirt roads, farm erosion and the drying Salton Sea, poses a health risk to residents, who have elevated rates of asthma. Obesity is associated with the development of asthma and worsening asthma symptoms, according to the CDC.
About 80% of the hospital’s COVID-19 patients had underlying health issues, Tomaszewski said.
“Now throw in a virus that takes advantage of the weakest,” he said.
At Frye Chapel and Mortuary in Brawley, white vans darted in and out of the parking lot one after another, day after day, delivering bodies. In July, they brought 130 – three times the normal monthly number.
Workers brought refrigerated storage units to hold the bodies, parking them behind the one-story building surrounded by palm trees.
In her 33 years in the business, Sheila Kruger, the facility’s manager, had never seen anything like it. The mortuary, one of two serving Imperial County, was overrun.
“We were just feeling panic,” she said. “We were just keeping our head above water.”
Concerned with staff safety, each body was fitted with a mask and then slid into a body bag until embalming, Kruger said. She said her heart broke each time she had to tell family members they couldn’t have services, and even had to deny a family’s request for an outdoor viewing in a parking lot.
When too many family members of the deceased tried to come into the funeral home to discuss arrangements, she started locking the door.
Can I see them? they would ask.
Again and again, the answer was no.
On a recent September morning, hundreds of people lined up for assistance at the Imperial Valley Food Bank’s monthly food distribution at Our Lady of Guadalupe Church in Calexico. Many waited in their cars, air-conditioning humming. Some arrived on foot and stood, with some social distancing, in a line that wrapped around the block. Others sat in lawn chairs next to pushcarts they soon filled with eggs, milk, frozen chicken, potatoes and bread.
Ivania Rocha, 60, arrived at 7 a.m., an hour before doors opened, and sat in a pink camping chair next to a black cart. She worked for years in Imperial Valley’s fields, harvesting broccoli, lettuce and watermelons, but stopped in March and hasn’t worked since. Rocha has diabetes and was afraid she would contract the virus, she said.
Her biggest concern: carpooling to the fields, as thousands of laborers do each day. Workers typically squeeze four to five in a vehicle and pay the driver, a fellow farmworker, $5 each for the roundtrip.
Rocha has heard of entire crews of field workers contracting COVID-19. They likely got it while traveling together, she said. Because crops become ready for harvest at different times, workers may end up driving an hour east to Arizona, or about 80 miles north to the Coachella Valley, to reach the field sites.
“There needs to be social distancing,” she said, “and there’s not going to be social distancing in the cars.”
Farmworker Guadalupe Serreno has worked in the fields for about two decades, harvesting onions, asparagus, lettuce, cauliflower and melons.
Usually, she migrates with the crops, following the onion harvest from Imperial County north to Bakersfield and then east to the Mojave Desert city of Lancaster. The workers, clad in pants and long-sleeved shirts to protect themselves from the sun and dust, clip the tops and bottoms off red, yellow and white onions, which are then dried in burlap bags before being transported to supermarkets.
On the road, Serreno, 42, shares the cost of a hotel room with three other laborers, often for weeks at a time.
That life halted March 21, as the pandemic infiltrated the United States. The agriculture company she works for hasn’t called with a job since. Even if it did, she’d be afraid of bringing the virus into the one-bedroom mobile home in El Centro she shares with her 70-year-old father and 4-year-old daughter, Luna, who has asthma and uses an inhaler twice a day.
“I thought it would last one, two months, and then we’ll return to work,” Serreno said. “I never thought it would last the whole year.”
Unemployed for seven months now, Serreno has had to stretch the little unemployment assistance she receives each month, along with her father’s Social Security and unemployment payments.
She saves money by buying fruit for Luna at the local 99 Cents Only Store. A bag of 15 apples or a large watermelon costs $1.99.
The door of the refrigerator in the small kitchen of their mobile home is speckled with magnets shaped like fruits and vegetables. Luna ticked off the contents of the fridge proudly in Spanish: “Manzanas, zanahorias, aguacates.” Apples, carrots, avocados.
The federal Special Supplemental Nutrition Program for Women, Infants and Children, or WIC, helps her buy milk, eggs and juice.
About 41,000 people in Imperial County receive federal Supplemental Nutrition Assistance Program (SNAP) benefits, known as food stamps, making it the third-highest county per household to receive the benefits in California, according to the U.S. Census. A 2017 study by researchers at North Carolina State University showed that SNAP, which disproportionately serves families of color, including Latinos, only covers up to 60% of what is considered a healthy diet under federal guidelines.
“Sometimes I think, ‘What if I don’t go back to work? What am I going to do?’” Serreno said. “I try to think positively and have faith.”
Esther Bejarano, a community health educator for Comité Cívico del Valle, a non-profit group in Imperial County, was in the border city of Calexico one day in early June to distribute economic relief information to farmworkers.
She approached a group of men sitting at a bus stop outside a doughnut shop a few blocks from the border and started chatting with them. It was about 11 a.m. and the sun was scorching. As they talked, the topic turned to the coronavirus. One of the men said he knew about 20 people who had contracted COVID-19, Bejarano recalled. Most of them had died, he told her.
The men started naming the crew leaders and workers who had succumbed to the virus, one after another, 20 in all. At that moment, it became clear to Bejarano that farmworkers were being disproportionately impacted by the virus.
“I couldn’t believe that he was saying names of individuals that he knew, and all of his colleagues knew, that had passed,” she said.
The man said he had stopped working for fear that he, too, would fall ill.
Bejarano said farmworkers could be easy targets for the virus in part because there are limited shade structures in the fields and workers crowd under them to eat lunch. There are also limited bathrooms, which everyone uses during breaks.
Some are making tough choices, like choosing to work while feeling ill, she said. Often, an entire day’s wages are immediately spent on groceries for the day.
“They’ve been in crisis forever,” Bejarano said. “They’re survivors.”
Farmers say they can’t exist without the workers – and that it’s important to them that they earn a fair wage under safe conditions.
Fourth-generation farmer Jack Vessey, 45, oversees operations at his family-owned, 10,000-acre farm, Vessey & Company, in Holtville, 10 miles north of the border. Workers pick crops including bok choy, cabbage, garlic and Romaine lettuce, which is hand-packaged for sale at Walmart and other major retailers. As president of the sprawling enterprise founded in 1932, Vessey does everything from check the condition of crops to buy $400,000 tractors and negotiate sales with salad companies.
Vessey employs up to 200 workers at a time, about half traveling across the border from Mexico and the other half living in the U.S. Despite Imperial County’s high unemployment rate, he said he often has a hard time finding workers willing to work for what he’s paying, up to $15-$20 an hour.
When the pandemic first hit, he left crops rotting in the fields because suppliers didn’t need them for now-closed restaurants.
While on his property, workers, who are primarily Latino, must wear masks and maintain six-foot distancing, he said. He discourages them from carpooling and urges them to wear masks if they do. California law mandates access to toilets and hand-washing stations.
“One of the most important things for us is to make sure that our workforce is as protected as possible,” he said.
Watching how the coronavirus consumed New York City 2,600 miles away, Dr. George Fareed hoped Imperial County would be spared the worst. But as doctors and public health experts learned more about who was most affected – those with preexisting health conditions – he feared for his neighbors. One of the worst outbreaks occurred at a nursing home, where dozens of infected patients spread the sickness to the staff.
“We felt we might have been spared when it hit New York and the East,” said Fareed, a family medicine practitioner who works at several health clinics in Imperial Valley. “That didn’t happen.”
As Imperial County’s coronavirus cases mounted, County Supervisor Luis Plancarte thought of the 20,000 to 25,000 people still crossing the border from Mexico into his county each day. Border crossings had been restricted since the start of the pandemic but essential workers – health care staffers, farmworkers and others – were being allowed to cross. Directly south, Mexicali, a sprawling city of 1 million, was grappling with its own COVID-19 outbreak and hospitals there were overwhelmed with patients.
Through a mix of private and federal donations, county officials stockpiled more than 3 million masks, Plancarte said. They deployed staffers to crossing points on both sides of the border and bus stations frequented by farmworkers, often before dawn as laborers arrived, to hand them out.
Plancarte said he knows a lot of people who have lost family members to the disease or have contracted the virus, including Imperial Irrigation District Director Jim Hanks, whose lung collapsed.
County leaders are focused on improving residents’ access to healthy food and, by extension, defeating the coronavirus, he said.
“The key to doing that is to improve the physical health of our community,” Plancarte said.
As cases mounted in March and April, Dr. Stephen Munday scanned the California Reportable Disease Information Exchange, a secure system used by county and state health officials. Beginning in May, when the county’s two hospitals reported overflows and called on state officials to transfer hundreds of patients to other hospitals, Munday knew they had trouble.
“That’s when things were at their bleakest,” he said.
Munday and other health officials issued countywide mask orders and called on state and federal agencies for personal protective equipment and virus tests. They also dispatched promotoras, or local health advocates, to heavily Spanish-speaking areas to better inform residents. By late summer, the surge started to ebb.
“I wouldn’t say we’re out of the woods,” Munday said. “We don’t know what’s going to happen next.”
José Alfredo Reyes worked in the fields of Southern California for nearly four decades, waking up before 4 a.m. and working until dark, through frigid winter mornings and triple-digit summer days.
For years, he breathed in pesticides that his family said left him with a chronic cough. The cough flared up every summer, especially when his crews were harvesting onions and corn. He developed asthma and hypertension.
“He never complained,” said his daughter, Cynthia Reyes, 35. “He loved his job. He liked to be outdoors.”
José Alfredo Reyes and his crew were harvesting onions when the pandemic hit in March. He continued working, wearing a mask and trying his best to keep a distance from other workers. The virus first struck his wife, Margarita Reyes, 60, causing her to faint in May at the money exchange store where she worked. She tested positive for COVID-19 and after spending one night at the hospital, returned home to fight the virus.
José Alfredo Reyes developed a cough but thought it was the same cough that had followed him for years from working in the fields. At his daughter’s insistence, he went to a local clinic — and tested positive. His fever shot up to 105 degrees and X-rays showed lungs mangled by the virus.
He went home to rest alongside his wife. But she eventually returned to the hospital. Then his oxygen levels plummeted. His daughter drove him to El Centro Regional Medical Center.
At a tent outside the hospital, he was screened and masked with oxygen. As they wheeled him away, Cynthia Reyes asked if she could hug her dad before he disappeared inside. “Hug him,” a nurse told her, “because he’s going to be here for a while.”
For two days, José and Margarita Reyes shared a hospital room. They chatted and watched the old Mexican movies that he loved so much. But as his breathing became increasingly labored, hospital staff fitted him with an oxygen mask that made it harder for him to talk. Margarita Reyes would talk. He would send text messages in reply.
On May 20, hospital staff announced they needed to move José Alfredo Reyes to a hospital in San Diego. His condition was worsening.
“I told him to get better,” Margarita Reyes recalled. “He blew me a kiss and waved goodbye.”
At Sharp Memorial Hospital in San Diego, José Alfredo Reyes was put into an induced coma and connected to a ventilator.
Margarita Reyes was released from the hospital on May 27. Her husband died three weeks later, on June 17.
At the family home in Calexico, a framed photo of José Alfredo Reyes — with his signature salt-and-pepper mustache — hangs in the center of a wall, surrounded by pictures of his siblings, four children and 14 grandchildren. Below the photos, a table holds vases filled with red roses and a burning St. Jude candle. His work hat and sunglasses still hang from a hook by the door.
His wife converted his collared work shirts into stuffed pillows. The pillows are scattered across the leather couch where he used to stretch out after long days in the fields.
On June 29, about two weeks after José Alfredo Reyes’ death, two El Centro police cars assisted Margarita Reyes and her family in bringing his ashes home from San Diego. Back in Calexico, about 20 cars filled with family members, friends and fellow farmworkers joined them, creating a procession that snaked through downtown, where José Alfredo Reyes would pick up workers before a day of labor, and past the Our Lady of Guadalupe Catholic Church, where he and his family worshipped.
The procession ended at the field where he and his crews harvested onions. Everyone in attendance wore white T-shirts emblazoned with his photo and nickname, Sabritas. They released black and white balloons, which floated over the dusty field and drifted into the sky.
Six days later, Cynthia Reyes, feeling fatigued and feverish, tested positive for COVID-19.
Contributing: Mark Nichols